Download CHAPTER 11

CHAPTER 11
SCHIZOPHRENIA
AND OTHER
PSYCHOTIC DISORDERS
PSYCHOTIC DISORDERS

Symptoms


Alternations in perceptions, thoughts, or
consciousness (delusions and hallucination)
DSM-IV categories








Schizophrenia
Schizophreniform disorder
Schizoaffective disorder
Delusional disorder
Brief psychotic disorder
Shared psychotic disorder
Psychotic disorder due to general medical
condition
Substance-induced psychotic disorder
SCHIZOPHRENIA

Symptoms




Disturbance lasts at least 6 months, including
One month of active phase that includes 2 positive
or one positive and one negative symptom, and
Decline in social or occupational functioning.
DSM-IV subtypes





Paranoid
Catatonic
Disorganized
Undifferentiated
Residual
POSITIVE AND NEGATIVE
SYMPTOMS


Positive
 Delusions – Faulty interpretations of reality
 Hallucinations – Faulty sensory perceptions
 Disordered speech
 Disorganized and bizarre behavior
Negative
 Flat affect
 Poverty of speech
 Lack of motivation or directedness
 Loss of energy
 Loss of feelings of pleasure
EXAMPLES OF NEGATIVE SYMPTOMS



Flat affect
 Avoid eye contact
 Immobile, expressionless face
 Lack of emotion when discussing emotional material
 Apathetic and uninterested
 Monotonous voice, low and difficult to hear
Poverty of speech
 Long lapses before responding to questions or failure to
answer
 Restriction on quantity of speech
 Slow speech
Loss of directedness
 Slow movements
 Reduction of voluntary movements
 Inability to initiate activities
 Little interest in social participation
CAUSES OF SCHIZOPHRENIA

No known cause, but research has focused on
 Genetic factors
 Schizophrenic spectrum disorders
 Neurodevelopmental model
 Family studies
 Twin studies
 Adoption studies
 Diathesis-stress theory and family and
community vulnerability
 High-risk studies focusing on family and birth
history and markers of attention and cognition
deficits
MRI SCANS OF IDENTICAL TWINS
AUDITORY HALLUCINATIONS
BRAIN SCANS OF GENAIN SISTERS
CET SCANS OF GENAIN SISTERS
PRENATAL EXPOSURE TO INFLUENZA
AND ADULT SCHIZOPHRENIA
THE FAMILY FACTOR IN SCHIZOPHRENIA
TREATMENT OF SCHIZOPHRENIA






Antipsychotic drugs – Some have adverse side
effect (tardive dyskinesia)
Skills training
Family programs
Community support
Combined treatment approaches
Long-term outcome studies- Prognosis poor
though deteriorative effects plateau after 5 to
10 years
SKILLS TRAINING




Social skills
 Self-awareness
 Affect regulation
 Social cue recognition
Cognitive skills
 Training in elementary cognitive functions
 Strategies for dealing with cognitive deficits
 Cognitive restructuring about source of
hallucinations
Self-care and symptom-identification
 Improved grooming and self-care
 Self-monitoring for symptoms of relapse
Skills for dealing with stress
 Identify indicators of stress
 Apply cognitive and behavioral techniques
FAMILY PROGRAMS





Education about probable causes,
symptoms. and course
Information about treatment
Instruction in problem-solving and crisis
management skills
Decease negative expressed emotion (EE)
Relapse recognition
BRAIN METABOLISM OF SCHIZOHPRENIC
AND NON-SCHIZOPHRENIC
OTHER PSYCHOTIC DISORDERS



Schizoaffective disorder – Delusions or
hallucinations combined with symptoms of
depression or manic mood
Delusional disorder – Less bizarre than
schizophrenia delusions; usually related to a
particular topic and have some foundation in real
life.
Shared psychotic disorder – Two or more people
who share shame delusional belief; one originates,
the other follows. Occurrence is rare.
DELUSIONAL CONTENT IN PSYCHOSES




Schizophrenia
 Variety of bizarre content
 Being controlled or persecuted by others
 Finding reference to oneself in other’s behavior or in
printed materials
Depression
 Unjustified guilty
 Perceived bodily changes
Mania
 Great self-importance
 Grandiosity
Delusional disorder
 Loved by celebrity/high-status person
 Suspect spouse or lover of being unfaithful
 Possession of special and unrecognized talent